Any hospital — but especially those in crisis and relying on government funding for recovery — can use knowledgeable assistance in implementing an electronic health records (EHR) system. Some simply require an efficient installation, while others need guidance in choosing the system and determining how it will be hosted.
The move to effective EHR is best made with the backing of experience.
The client is a large nonprofit hospital — 500+ beds — in the northeastern United States, funded and directed by the state. The hospital provides ambulatory, inpatient and long-term care.
Of the six hospitals in the area, three have been closed. Others, including this one, were under scrutiny for possible closure.
The hospital went into major restructuring mode to keep the doors open. As part of the restructuring, the state mandated that the hospital implement EHR.
The EHR system chosen was Epic, which according to the Advisory Board Company supplies most of the EHR implementations in the country. Epic is often the system put in place for hospitals supported by state or federal government.
EHR was a key component of the hospital turnaround:
The EHR project had to be done quickly to turn around the hospital performance.
The hospital didn’t have the infrastructure and staffing to complete the implementation and host the Epic system. Epic encourages full-time staffing, which was not available, and requires that staff be certified for the implementation. The hospital’s staff could not do the necessary customization and could not handle the hosting volume.
The Grant Thornton solution
For the restructuring, the state engaged the Health Care Advisory Services professionals of Grant Thornton LLP as interim management. The state also removed the existing management company and engaged Grant Thornton for this service, as well.
The Health Care Advisory Services (HCAS) team studied the business case and decided what needed to be done and how. In customizing the implementation, they eliminated some Epic standard processes as unnecessary. The team wanted to make sure the process and workflow were for the client’s benefit — using the software as a tool and not the point of the project. This seems obvious, but in an implementation, especially one undertaken by the hospital IT department, the purpose can get lost in seeking success in day-to-day tasks.
The HCAS team set out to streamline and coordinate the system to track a patient’s entire visit, from admittance to scheduling to clinical documentation and orders to posting charges and billing. In all, 14 individual applications and modules were tied together (an Epic “big bang” implementation). EHR central control was built and maintained for the individual patient record.
Hospital staff training came next. In customizing the training, HCAS observed employees at work and verified the workflows through numerous processes. In this way, the team could match what people actually needed to learn with what they actually do. This role-based training is fairly unique. In most cases, training is an application-based blanket: everyone is trained in every aspect of the process, whether they’ll ever need to know it or not.
HCAS then determined that because of the needs of the organization, it made sense to go to a third-party host. This is rarely done for an Epic system, but it’s what works for this hospital.
The hospital, including the ED, was completely converted to EHR primarily from a paper record, and the core infrastructure was moved and upgraded at a hosted vendor facility.
This was accomplished in an extremely short time frame — a typical implementation requires 18–24 months; HCAS’s implementation took just nine months.
There was minimal disruption to hospital operation, few incidents, efficiency in troubleshooting, effective coordination of vendors, and low call volume to the service desk during go-live.
Nearly 3,000 employees learned the system on a JIT basis, so there was no loss to a time lapse between training and use. Employees began immediate work in the new system.
The hospital continues to operate.
Do you have similar challenges?
A system can be efficiently customized for your organization, with practical training for staff. We can work with you to determine your strategic goal, and help with tactical decisions to achieve it.
- The state had mandated its implementation, and the existing financial electronic billing system wouldn’t be supported by the vendor past summer 2014.
- The hospital had to quickly improve its clinical and financial performance to assure continued state support.